Malpositioned IUCD: the menace of postpartum IUCD insertion

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By Manasi Jiwrajka

The three cases presented by Nigam et al outline the malposition of an intra-uterine contraceptive device (IUCD) in young women who had given birth in the previous 1-2 years.

Some significant global health problems in this report are:

  1. The importance of contraception and family planning in India
  2. Contraceptive options available for women

Family planning and population control

India has an interesting history of government level family planning options including a mass sterilisation campaign initiated in the 1960s and more recently, one that received much media attention due to 12 women who died at a government-run tubectomy camp. (1)  The Indian government has advertised vasectomy, tubal ligation and other reversible and temporary contraceptive methods for population control. In fact, there are government incentives for those who undertake sterilisation surgery, a tradition held on since the 1970s emergency and poverty-stricken period in India. (2) More than sixty years later, India continues to struggle with its population, and it appears that the mass sterilisation attempts have failed to adequately control the booming population.

Contraceptive options available

My experience of working in resource-poor settings in India has been that many women do not want to give birth immediately after marriage, or immediately after having given birth to a baby, but face enormous pressure from their husbands and families to give birth again. One big factor in India is that of a son preference, which results in families trying to conceive until they have a son or more. (3) As such, many women prefer concealed approaches to birth control that they do not have to justify to their families – such as the depot or the IUCD. A recent study investigated the influence mother-in-laws have on contraception and family planning decisions because they found that “in casual discussions during the intervention project, rural women often mentioned that mothers-in-law were opposed to young women’s desire to limit family size.”(4)

Some real solutions or alternatives to sterilisation and these reversible contraceptive methods are fundamental. Some include: (i) Spacing out children, (ii) Delaying first pregnancy, and (iii) Education of both men and women.

What do you think? Are there other alternatives and solutions?

References

  1. Burke J. India mass sterilisation: women were ‘forced’ into camps, say relatives. The Guardian. 2014.
  2. Matthews Z, Zoë M, Sabu SP, Inge H, Juliet M. Does early childbearing and a sterilization-focused family planning programme in India fuel population growth? Demographic research. 2009;20:28.
  3. Char A, Saavala M, Kulmala T. Influence of mothers-in-law on young couples’ family planning decisions in rural India. Reproductive health matters. 2010;18(35):154-62.
  4. Pachauri S. Priority strategies for India’s family planning programme. The Indian Journal of Medical Research. 2014;140(Suppl 1):S137-S46.